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Cost of OR Time is $46.04 per Minute

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Objectives: The purpose of this study is to establish a consensus estimate of operating room cost per minute based on currently published literature. Design: Literature review. Main outcome measurement: Operating room cost per unit time. Results and conclusions: Google Scholar search produced 51 articles regarding ““operating room cost per minute” of which 14 had novel estimates for OR cost per minute. The mean of these estimates was 46.04±46.04 ± 32.31. There was little consistency in methodology among the included articles, which is reflected in the large range of values. Level of Evidence: IV; Review Keywords: Business, management, human resources, cost, value, efficiency. (J Ortho Business 2022; Volume 2, Issue 4: Pages)
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Cost of Operating Room Time is $46.04 Dollars per Minute
Tyler Scott Smith, BSA1, Justin Evans, BS1, Karla Moriel, BS1, Mikel Tihista MD1, Christopher Bacak1, John
Dunn MD1, Rajiv Rajani MD1, Benjamin Childs MD1
1) Texas Tech University Health Science Center El Paso Paul L Foster School of Medicine, El Paso, TX
JOB | @JOrthoBusiness | JOrthoBusiness.org | October 1, 2022, Vol 2, No 4 | Copyright © 2022 Journal of Orthopaedic Business Incorporated
Journal of Orthopaedic Business
Objectives: The purpose of this study is to establish a
consensus estimate of operating room cost per minute based
on currently published literature.
Design: Literature review.
Main outcome measurement: Operating room cost per unit
of time.
Results and conclusions: A Google Scholar search produced
51 articles regarding “operating room cost per minute,” of
which 14 had novel estimates for OR cost per minute. The
mean of these estimates was $46.04 ± $32.31. There was little
consistency in methodology among the included articles,
which is reflected in the large range of values.
Level of Evidence: IV; Review
Keywords: Business, management, human resources, cost,
value, efficiency.
(J Ortho Business 2022; Volume 2, Issue 4: Pages 10-13)
INTRODUCTION
Value based practice, defined as weighing the cost of
treatment against the change in patient quality of life, has
become an important consideration in treatment planning in
orthopaedic surgery 1 2 . High costs 3 4 draw the attention of
payers, while discrepancies in reimbursement disincentivize
surgeons 5 6. Ultimately what matters most is the ability to
provide better outcomes per healthcare dollar spent 7. While
significant effort is being put into measuring patient reported
outcomes 8, we must also clarify the true costs in healthcare. A
major factor of healthcare costs pertinent to the orthopaedic
surgeon is the costs associated with the operating room (OR).
The number of measurable and associated factors is vast and
remains poorly defined in the literature. This has contributed
to the ongoing controversy regarding actual cost per unit time
in the OR.
The cost to run an operating room can be divided into
direct costs such as staff wages and consumable items, indirect
costs such as building maintenance, leasing/mortgage
payments and laundry services, professional fees such as
anesthesia and surgeon fees, and specialty service fees such as
intraoperative fluoroscopy, blood bank, lab, and orthopaedic
implants9. Most of these figures can be estimated from
purchase orders and salaries payable by hospital accounting
systems 10. More recently, time driven activity-based costing
(TDABC) has allowed a more accurate way to assign cost in a
complex environment where staff are often multi-tasking and
thousands of consumables are utilized. TDABC divides
complex care into discrete cycles allowing micro-costing
assessment and assignment of cost based on time11.
In either of these methods, decisions must be made
when attempting to measure and/or conceptualize the actual
cost of a surgery. It should be noted that data in the current
literature pertaining to the cost of the operating room often12,
but not always13, excludes the costs associated with anesthesia
services, perioperative services, surgeon fees, blood bank
expenses, radiology services, and implants. Consistent data on
operating room costs is needed for effective healthcare
resource allocation. The purpose of this study is to review
available literature estimating the cost per minute of running
an operating room.
METHODS
Literature search was performed in Google Scholar
and PubMed for “operating room cost per minute”. All article
titles were reviewed by both authors, and either discarded or
selected for further review. Abstracts of selected articles were
reviewed and those that had novel estimates for operating
room cost per minute were included. Papers were excluded if
they focused on costs for procedures, considering the large
mean discrepancy in the procedural cost of an average
orthopedic procedure versus an open-heart surgery
necessitating a full team to operate a heart lung bypass
machine. The methods of the remaining articles were
scrutinized to determine what was included in the cost and
what was excluded. Where applicable, a single number was
extracted to calculate the mean cost per minute. For articles
that only reported a range, we took the median of the range
Smith et al OR cost $46 per minute
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Table 1. All estimates of OR cost per unit time found in literature.
Author
Year
OR $/min
OR $/min
inflation adj
Included
Excluded
Childers
2018
$37.45
$44.19
OR staffing, cleaning and maintenance salaries,
sterile processing, consumable supplies, recovery
room costs
Anesthesia, implants,
radiology, pathology and
blood bank
Park
2009
$20.83
$28.77
Salary and benefits, supplies, drugs, services,
depreciation
Moody
2018
$16.21
$19.13
OR staffing, medications, supplies, salaries,
equipment depreciation, training, hospital
overhead
Anesthesia, physician
services, soft goods,
implants
Shippert
2020
$62.00
$71.89
OR fees, anesthesia
Maskal
2020
$64-$115
$73- $131
Undisclosed
Anesthesia
Holloran-
Schwarts
2013
$94.14
$119.73
Support staff salaries, drapes, room maintenance,
use of non-chargeable items
Professional fees of surgeon
or anesthesia
Abbott
2007
$18.47
$26.39
Staff, heating, lighting, basic consumables
Taravella
2012
$11.24
$14.50
Hospital accountant estimate
Koehler
2016
$29.44
$36.34
Staff ($2.70/min), direct costs ($11.52/min),
overhead ($15.22/min)
Physician labor
($12.29/min)
Chapa
2010
$50
$67.94
Estimate based on published charges
Hamid
2014
$23.20
$29.03
Direct and indirect costs
Ackerman
2002
$18
$29.64
Undisclosed
Polacco
1998
$18
$32.72
Operating room use
Anesthesia staff
Gilardino
2015
$17.50
$21.88
Undisclosed
Mean
$36.14
$46.04
reported. We extracted the fiscal year for the cost estimate
when available and used the publication year when it was not.
All figures were adjusted for inflation to 2022 dollars.
RESULTS
Literature search generated a total of 51 articles.
Thirty-seven of these articles were excluded after title review.
Of this thirty-seven, twenty-eight were excluded because they
did not have novel estimates, six were excluded because they
were not peer reviewed journals, and three were excluded for
poor methodology and/or concern for quality. Of the fourteen
articles included, three were specific to orthopaedic
procedures. Five out of fourteen articles explicitly excluded
anesthesia costs and specialty service costs. The mean cost per
minute adjusted to 2022 dollars from all fourteen papers was
$46.04 per minute of OR time with a standard deviation of
$32.31.
DISCUSSION
The purpose of this study was to determine the
inflation-adjusted cost of one minute of operating room time
based on the reported data available within the current
literature. From the fourteen articles that met our inclusion
criteria, it was determined that the estimated mean inflation-
adjusted cost per minute of operating room time is $46.04 (at
the date of publication). There were several notable findings
from this review that must be considered, including vast
discrepancies in differential cost reporting, how the value of
Smith et al OR cost $46 per minute
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the operating room should be determined, and the lack of
correlation of cost to reimbursement and patient outcomes.
It was found that there was a large discrepancy with
regards to the costs measured in the reported price-per-minute
among the included articles. The majority of articles did not
include the cost of anesthesia care with the exception of one
study14. Additionally, one article included perioperative
recovery room costs15, and one included cost for trainings and
CME16. While specialty services costs such as blood bank
expenses and radiology support differ greatly by case, most
operative cases require the same anesthesia burden, and this
cost would be relevant to factor in with future studies. It was
also found that several of the articles used figures supplied by
the hospital with little mention of how the number was
calculated. This lack of rigor and varying degree of
included/excluded associated costs may contribute to the wide
range of numbers for OR cost per minute, which was found to
be from $14.50 to $131.65. This led to a standard deviation
that was 75% of the mean. With future cost assessment, it
would benefit decision makers to have a consistent way to
measure operating room costs in order to benchmark
performance and decide how to allocate resources.
Another confounding factor identified during the
current review is how to account for indirect costs such as
building maintenance for ORs that are not always in use.
Operating rooms that are dormant are significantly less
costly17, however there were few estimates for how the
vacancy rate affects the overall cost. A cost-to-profit ratio
would be helpful to determine the benefit of having and
maintaining lower volume ORs within smaller health care
facilities. This would be in contrast to larger markets where
operating rooms are used well into the night, which may
generate lower cost per minute, but the increased overhead for
support staff and services allocation would need to be adjusted
for. Understanding contributing factors and their respective
financial implication with operating room cost would better
enable appropriate resource allocation. For example, hiring
extra staff to reduce room turnover time may lead to a
reduction in overall cost, as a greater number of cases could be
done per unit time, maximizing the cost-to-profit ratio.
While this study determined the estimated inflation-
adjusted cost of the operating room per minute, there remains
a lack of correlation of this cost to care reimbursement and
patient outcomes. Further research is warranted in order to not
only extrapolate a precise, reproducible standard for how
operating room costs are measured and accounted for, but
their effect on patient outcomes.
CONCLUSION
In conclusion, the mean cost for one minute of
operating room time estimated from the literature is $46.04.
For most articles, this excludes anesthesia and specialty
services. Further research is warranted to refine methodology
and determine algorithmically a more precise and reproducible
approach to measure the cost of OR time.
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... As the third most frequent type of fracture in the upper extremity, metacarpals fractures account for approximately 40% of all acute hand injuries, 20% of all fractures occurring below the elbow, and are the most common hand injury amongst [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] year olds [5,6]. While metacarpal fractures are often amenable to conservative treatment, surgical fixation is occasionally and for a variety of reasons preferable, especially for more complicated and severe injuries [7]. ...
... Although a 19 minute difference might seem modest for an individual case, more than 282,000 metacarpal fractures yearly are reportedly subject to surgical treatment in the US [5,17]. Applying these numbers to estimated OR costs amounting to $46.04 ± 32.31 per minute [18], potential savings that hypothetically may be in the range of $247M-$421M in the US alone may be based solely on the surgeons choices of hardware for internal fixation of metacarpal fractures. ...
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Introduction Time spent in the operating room (OR) has ramifications that impact patient outcomes and the economics of patients, physicians, surgery centers, and insurance industry. For that reason, there is an incentive to seek approaches that allow shorter times to be spent in the OR. To what extent varying routine techniques impact on operating times has not been extensively studied in metacarpal fixation literature, specifically investigating retrograde threaded intramedullary nail fixations (RTNF) and comparing it to open plating fixations (OPF). The present study was designed for the purpose of comparing OR times for different but broadly adopted techniques for internal stabilization of metacarpal shaft fractures. Methods A retrospective chart review was conducted for patients aged 18 and above, who over a 41-month period underwent internal fixation with RTNF or OPF for single, extra articular, closed fractures of the index through little finger metacarpals. We examined anesthesia records, which indicated total operating (“skin-to-skin”) times. Results A total of 81 charts remained for review after exclusions. Statistical analysis of the recorded data showed significantly shorter median OR time values for RTNF (17 minutes, IQR = 14 – 20.75) vs. OPF (36 minutes, IQR = 31.55 – 44; p < 0.001). Conclusion Statistical analysis of data shows significantly shorter operating times to achieve satisfactory fracture stabilization using RTNF compared to OPF. Since the differences in OR time significantly differ between the two principally different surgical techniques, it should be considered when choosing which surgical technique to use. However, further review of indications and clinical outcomes is necessary to develop definitive recommendations or guidelines on which technique should be preferred, especially when considering specific patient presentations. Level of Evidence Retrospective Comparative Study III
... The duration of surgeries (excluding same stay revisions) was used to estimate cost of care in the OR considering current bench marks [14,15]. In order to consider the full range of potential OR costs of care (in United State Dollars, USD, $), lower ($14.5/min), ...
... Compared to conservative therapies like vaccination, surgery requires more infrastructure and particularly initial investment with recurring costs for maintenance and depreciation. Therefore, we integrated both lower and upper including mid-situated mean OR cost per minute in order to optimally depict the whole range (starting from $14.5/min up to $131.65/min [15]) of potential cost of care in the OR concerning surgical treatment of posttraumatic spinal cord tethering and syringomyelia. While lower mean costs of care in the OR are most likely reflecting smaller surgical units in primary care centers, higher costs are predominantly resulting from tertiary care centers with modern and usually expensive infrastructures [14]. ...
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... Furthermore, the authors highlighted a higher dissatisfaction rate associated with surgeries performed during night shifts, reported by 43% of orthopedic surgeons, 81% of anesthesiologists, and 84% of nurses [14]. The duration of surgeries is also linked to the mean cost of operating room time, which, based on the literature, is estimated at USD 46.04 per minute [31]. Notably, reductions in on-call operating room costs are associated with improved staff satisfaction, with dissatisfaction rates among night-shift staff mirroring those previously mentioned [20]. ...
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Background/Objectives: Supracondylar humerus fractures (SCHFs) are the most common pediatric elbow injuries and often require surgical intervention. Despite guidelines, optimal timing for surgical management, particularly for cases without neurovascular compromise, remains unclear. This study evaluates the influence of surgical timing on short-term outcomes, focusing on fracture reduction quality and surgical parameters. Methods: In total, 62 pediatric patients who had been treated for Gartland type II and III SCHF between 2018 and 2023 were retrospectively assessed. Patients were grouped based on time of admission (morning, afternoon, early evening, and night shifts) and time to surgery (<12 h vs. >12 h). Primary outcomes included immediate radiological reduction, assessed via the Baumann’s angle (BA) and shaft-condylar angle (SCA). Secondary outcomes encompassed surgery duration and radiation exposure. Statistical analyses used ANOVA and chi-square tests, with p < 0.05 considered significant. Results: No significant differences were observed in BA (p = 0.84) or SCA (p = 0.79) between early and delayed surgical groups. Similarly, surgical timing (shift or delay >12 h) did not significantly affect surgery duration (p = 0.92) or radiation exposure (p = 0.12). The complication rate was 6.45%. Conclusions: Surgical timing, including delays beyond 12 h, does not adversely affect short-term outcomes in SCHFs. However, after-hours procedures may pose practical challenges, emphasizing the importance of surgeon experience and institutional protocols. Larger prospective studies are warranted to validate these findings and examine them in the long term.
... 41,42 In recent decades, the cost per minute in the operating room has increased from 20 dollars to 46 dollars per minute. [43][44][45] With an increase of 1% per minute, longer operative times can significantly increase the risk of complications, especially when procedures increase by 1 or 2 hours. Although operative time has independent factors that may be related, such as the experience and efficiency of the surgeon, patients with obesity can be referred to more experienced surgeons to avoid longer operative time and thereby reduce the risk of complications without affecting the results of the surgery. ...
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... Therefore, a novel compound must be developed for each tumour type to be targeted, preclinically tested and then subjected to clinical approval, in a temporally (over a decade) and financially (~US$100-200 million) very costly process 10,11 . The 'by the minute' charges for surgical room use (average of USD$46.04 per min in 2022) where FGS requires additional time for the fluorescence imaging further hinders translation, preventing preclinically validated fluorophores from having the highest possible impact 3,12,13 . FGS patients normally receive a single dose of the compound, and this (combined with the high costs of bringing such a compound to market) provides yet another barrier to translation 10,14 . ...
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Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = -14.32 [-19.37, -9.28]), SL MD = -20.16 (-10.84, -29.47), and AC MD = -18.32 (-1.25, -35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.
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Background: Accurate estimation of surgical procedure times, crucial for optimizing healthcare access, patient outcomes, and cost-effectiveness, is essential for operating room efficiency. Surgical control time (SCT) is a preoperative estimate by surgeons representing their predicted time to complete the surgery, spanning from completion of anesthesia induction to surgical site closure. Methods: In this within-subjects, longitudinal study, we examined the differences between predicted surgical control times versus actual SCTs and determined variability by surgical specialty. We included cases regardless of classification (i.e., outpatient or inpatient), type of surgery (i.e., elective, urgent, or emergent), or level of complexity (i.e., major or minor). We ran Shapiro–Wilk tests to assess the normality of the difference in actual versus predicted surgical control times (dSCT) by surgical specialty. We used a generalized linear model (GLM) with robust clustered variance and pairwise comparisons of surgical specialties (with Bonferroni adjustment for family-wise error rate) to assess differences in the prediction accuracy of SCTs by specialty. Results: We analyzed 14,438 surgical cases performed by 168 surgeons across 13 specialties from January 2019 to January 2023. 11 of 13 specialties had higher actual than predicted times, suggesting an overall pattern of underestimating SCTs. On average, surgeries took 12.3 % longer than predicted, with surgeons underestimating SCTs by an average of 10.4 min. SCTs comprised 78 % of the total operative time. The four specialties with the largest underestimations of SCTs were neurosurgery (27.04 min), orthopedics (22.75 min), urology (19.4 min, and plastic surgery (18.67 min), while two specialties exhibited overestimations, namely ear nose and throat (11.14 min) and pediatrics (–3.21 min). GLM results and pairwise comparisons showed that surgeons significantly differed in their SCT prediction by surgical specialty. Conclusions: Our findings showed significant differences across surgical specialties in the accuracy of predicting surgical control times. These results have implications for integrating evolving technologies such as artificial intelligence and machine learning models to assist surgical administrators in accurately predicting surgical case durations and optimizing resource allocation.
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Objectives: Review business related shoulder and elbow articles in tope general orthopaedic journals and compare to top shoulder and elbow subspecialty journals. Design: Literature review. Intervention: General orthopaedic vs subspecialty journals. Main outcome measurement: Publication type, subject, methods Results: There were a total of 21 shoulder and elbow related business articles across JBJS, B&JJ, CORR, and AAOS during the study time period. That accounts for 0.3% of total publications (21/6098) and 8% of the business publications (21/261) in these journals over this 5 year span. Shoulder and elbow business publications accounted for a wide range of editorial space, ranging from 0% of CORR business publications to 11% of BJ&J publications. Across the five shoulder and elbow surgery journals of interest, there were 57 business related articles published for the 5-year duration. The Journal of Shoulder and Elbow Surgery accounted for 77% of these publications (44/57). Business articles represented 0.8% of articles in the fine shoulder and elbow publications (57/7155) over the study time period. Conclusions: This analysis demonstrates the tendency of shoulder and elbow oriented orthopaedic journals to publish a higher percentage of business articles related to shoulder and elbow surgery compared to general orthopaedics journal. The composition of these business articles demonstrates the recent focus on cost analysis of outpatient shoulder arthroplasty as well as factors that drive cost of shoulder and elbow procedures. The subject of shoulder and elbow business related articles in these journals over the last 5 years demonstrates that this field is increasingly interested in outpatient procedures and identifying ways to safely improve cost efficiency. Level of Evidence: IV review Keywords: Orthopaedic business, shoulder and elbow, cost, value based care, finance, shoulder arthroplasty, total shoulder. (J Ortho Business 2022; Volume 2, Issue 3:pages 18-31)
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Objectives: The purpose of this study is to report the incidence and patterns of injuries, surgical interventions performed, and healthcare costs associated with unlawful border crossings. Design: Retrospective Review Setting: Level 1 Trauma center on US-Mexico Border Main outcome measurement: Demographic and treatment data Results and conclusions: 111 patients were identified with an average age of 32 ± 12 years (range 6-60), and 56% were males. Monthly frequency of admissions was 0.75 in 2017, 1.33 in 2018, and 7.1 in 2019 (p<0.001). Median length of stay was 4 days (interquartile range 2-8). There was a total of 178 orthopaedic injuries (24 upper extremity, 123 lower extremity, 10 acetabular and pelvic ring, 21 spine). Pilon fractures were the most common injury pattern noted (N=33, 19%). Injuries resulted in 146 operative events, 231 procedures, 344 hours of operative room time, and 711 hospital days. 98 patients (88%) received definitive fixation, 13 (12%) had further surgery recommended without ability to follow-up. 92% of patients had no outpatient follow up. Total estimated cost of trauma utilization, diagnostic imaging, operating room utilization, implant costs, inpatient services, and Department of Homeland Security agent supervision was nearly $13.5M over the three-year study period. Injuries associated with unlawful border crossings are complex, costly, and challenging to treat. This is the first study that attempts to quantify the rates of orthopaedic-related hospital admissions, costs, types of injuries sustained, and orthopaedic surgeries being performed on this patient population. Level of Evidence: IVKeywords: Trauma, Pilon, Plateau, Border (J Ortho Business 2022; Volume 2, Issue 3:pages 5-11)
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Objectives: The purpose of this study is to compare the proportion of business articles in top general orthopaedic journals. Design: Review. Intervention: Categorize all articles from general orthopaedic journals with top four H-Index. Main outcome measurement: Articles categorized as payer analysis (PA), cost analysis (CA), value-based practice (VBP), Management and human resources (HR), practice efficiency (PE) and the business of scholarship (SC). Results and conclusions: JBJS, B&JJ, CORR, and JAAOS were identified as top orthopaedic journals. All had some level of business scholarship with an average of 3.4% of articles dedicated to business, ranging from 2 to 7%. Of business-related articles 27% of articles were cost analysis, 25% focused on practice efficiency, 22% on Value based practices, 16% payer analysis, 7% business of scholarship and 4% on human resources. The lack of scholarship regarding human resources represents a significant opportunity for improvement as a profession. Level of Evidence: IV; Review Keywords: Business, management, human resources, cost, value, efficiency. (J Ortho Business 2021; 2:9-12)
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Objectives: The purpose of this study is to compare Medicaid reimbursement rates with regional Medicare reimbursement for 10 commonly performed orthopaedic sports medicine procedures. Design: Database review. Setting: State Medicaid physician fee schedules and national Medicare fee schedule. Intervention: Medicaid and Medicare reimbursement for meniscus debridement (medial or lateral), meniscus repair (medial or lateral), anterior cruciate ligament (ACL) reconstruction, posterior cruciate ligament (PCL) reconstruction, anterior labral (Bankart) repair, rotator cuff repair, biceps tenodesis, femoral osteochondroplasty, acetabular osteoplasty, and acetabular labral repair. Main outcome measurement: Overall Medicaid to Medicare reimbursement ratio, dollar difference between Medicaid and Medicare reimbursement, dollar difference between Medicaid and Medicare per relative value unit (RVU), dispersion of reimbursement rates. Results and conclusions: Significant discrepancies were found between Medicaid and Medicare reimbursement for all 10 procedures, with Medicaid reimbursing on average 65.15% of the Medicare rate. Medicaid reimbursement also exhibited substantial variation between individual state programs. Financial incentives matter and between these two government programs, orthopaedic surgeons are incentivized to provide care to elderly patients over poorer patients. Level of Evidence: IV; Economic Analysis Keywords: Medicaid; Medicare; Reimbursement; RVU; Variation (J Ortho Business 2021; 1:4-6)
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Objectives: To evaluate the charges for pertrochanteric hip fracture care in Texas. Design: Database review. Setting: Texas Hospital Inpatient Public Use Data File (PUDF) Intervention: Charges reported by hospitals to the Texas Department of State Health Services for pertrochanteric hip fractures. Main outcome measurement: Charges associated with pertrochanteric hip fracture stratified by implant type and according to facility trauma level designation, urban versus rural, teaching versus non-teaching, and border versus inland status. Results and conclusions: There were a total of 44,853 pertrochanteric hip fracture surgeries performed over the three-year period in the state of Texas. The vast majority were treated at urban (93.4%), inland (non-border) (92.3%), non-teaching (74.2%) facilities with intramedullary fixation (56.9%). A significant increase in charges was associated with treatment at an urban (32,412),border(32,412), border (44,919), or teaching (10,501)facility.MeaninpatientchargesatLevelIIfacilitieswas10,501) facility. Mean inpatient charges at Level II facilities was 113,700. Further study is warranted to determine what drives the differences in charges associated with hip fracture treatment. Level of Evidence: IV; Economic Database Analysis Keywords: hip fracture, access to care, charge analysis, value-based care, Texas. (J Ortho Business 2022; 1:4-6)
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Intro: Medicaid is an important means of health care insurance for millions of people in the United States and 49.5% of Medicaid patients are children. . Reimbursements in Medicaid have been shown to be a limiting factor in access to health care in pediatric patients. This study investigates the amount of difference in reimbursement between Medicaid and Medicare, as well as state to state variability. Methods: Medicaid and Medicare fee reimbursements were collected from each state for 10 different common pediatric orthopedic procedures. The difference between and variability of reimbursement were calculated for both Medicaid and Medicare. Results: There was an average difference of -22.2% ± 26.9 or -184.14±184.14 ± 226.89 in Medicaid reimbursement compared to Medicare. New Jersey had the greatest difference at 72.7% less reimbursement with Medicaid, while Delaware had higher Medicaid reimbursement of 95.2% compared to Medicare. Only three states had higher reimbursement with Medicaid compared to Medicare for all 10 procedures. Additionally, there was statistically higher coefficient of variation with Medicaid reimbursement compared to Medicare (0.26 vs 0.46) among states. Conclusion: Medicaid reimbursement is significantly lower compared to Medicare for several common pediatric orthopedic procedures across the United States. The lower Medicaid reimbursement fees may contribute as a barrier to care access for an at-risk population of children.
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Objectives: To compare Relative Value Unit (RVU)-based reimbursement of operative fixation of complex carpal trauma versus primary operative fixation of distal radius fractures. Design: Database review. Setting: National Surgical Quality Improvement Program (ACS-NSQIP) database Intervention: Surgical treatment of complex carpal trauma and distal radius fracture. Main outcome measurement: Mean and median total work Relative Value Unit (wRVU), surgical time, wRVU/minute, reimbursement/minute, reimbursement/surgical case. Results: The 139 patients who underwent fixation of complex carpal trauma and 222 patients who underwent fixation of distal radius fractures were included in this study. The mean wRVUs were 10.56 for the complex carpal trauma group and 12.46 for the distal radius fracture group. Complex carpal trauma cases were an average of 31 minutes longer than distal radius fracture cases. Mean wRVU/minute (0.19 vs 0.14) and median wRVU/minute (0.18 vs 0.11) were higher for distal radius fracture cases than for complex carpal trauma cases (percent difference: mean 34%, median 62%). Lastly, the mean (378.85)andmedianreimbursement(378.85) and median reimbursement (383.29) per surgical case for complex carpal trauma was lower than that of the mean (447.19)andmedianreimbursement(447.19) and median reimbursement (516.08) of distal radius fractures. Conclusions: Despite longer operative times and increased procedural complexity, surgical treatment of complex carpal trauma is reimbursed significantly less than surgical treatment of distal radius fractures. The authors advocate a threefold plan. First, the ACS may consider developing more clear guidelines on the definition of a hand surgeon. Second, hand surgeons must insert themselves into hospital policy making, particularly with call and consult management discussions. Finally, considering the three components of the RVU calculation (physician work, physician expertise, and liability), the management of complex carpal trauma is under-recognized and reimbursed. As such, the authors recommend consideration of these injuries to be recompensed commiserate with arthroplasty and orthopaedic trauma. Level of Evidence: IV; Economic Analysis Keywords: Complex carpal trauma, relative value unit, wRVU, reimbursement, distal radius fracture (J Ortho Business 2022; Volume 1, Issue 1:pages 19-23)
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Patient-reported outcomes (PROs) can be included in clinical trials as primary or secondary endpoints and are increasingly recognized by regulators, clinicians, and patients as valuable tools to collect patient-centered data. PROs provide unique information on the impact of a medical condition and its treatment from the patient’s perspective; therefore, PROs can be included in clinical trials to ensure the impact of a trial intervention is comprehensively assessed. This review first discusses examples of how PRO endpoints have added value to clinical trial interpretation. Second, it describes the problems with current practices in designing, implementing, and reporting PRO studies, and how these problems may be addressed by complying with guidance for protocol development, selecting appropriate PRO measures to match clinically motivated PRO hypotheses, minimizing the rates of avoidable missing PRO data, analyzing and interpreting PRO data, and transparently reporting PRO findings.
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Purpose: In order to effectively improve value in health care delivery, providers must thoroughly understand cost drivers. Time-driven activity-based costing (TDABC) is a novel accounting technique that may allow for precise characterization of procedural costs. The purpose of the present study was to use TDABC to characterize costs in a high-volume, low-complexity ambulatory procedure (endoscopic vs open carpal tunnel release [CTR]), identify cost drivers, and inform opportunities for clinical improvement. Methods: The costs of endoscopic and open CTR were calculated in a matched cohort investigation using TDABC. Detailed process maps including time stamps were created accounting for all clinical and administrative activities for both the endoscopic and the open treatment pathways on the day of ambulatory surgery. Personnel cost rates were calculated accounting for capacity, salary, and fringe benefits. Costs for direct consumable supplies were based on purchase price. Total costs were calculated by aggregating individual resource utilization and time data and were compared between the 2 surgical techniques. Results: Total procedural cost for the endoscopic CTR was 43.9% greater than the open technique (2,759.70vs2,759.70 vs 1,918.06). This cost difference was primarily driven by the disposable endoscopic blade assembly ($217), direct operating room costs related to procedural duration (44.8 vs 40.5 minutes), and physician labor. Conclusions: Endoscopic CTR is 44% more expensive than open CTR compared with a TDABC methodology at an academic medical center employing resident trainees. Granular cost data may be particularly valuable when comparing these 2 procedures, given the clinical equipoise of the surgical techniques. The identification of specific cost drivers with TDABC allows for targeted interventions to optimize value delivery. Type of study/level of evidence: Economic Analysis II.
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Economic evaluation provides a framework to explicitly measure and compare the value of alternative medical interventions in terms of their clinical, health-related quality-of-life, and economic outcomes. Computerized economic models can help inform the design of future prospective studies by identifying the cost-drivers, the most uncertain parameter estimates, and the parameters with the greatest impact on the results and inferences. An economic analysis of bone morphogenetic protein versus autogenous iliac crest bone graft for single-level anterior lumbar fusion poses several methodologic challenges. This article describes how such an economic evaluation may be framed and designed, while enumerating challenges, offering some solutions, and suggesting an agenda for future research. An evidence-based modeling approach can incorporate epidemiologic, clinical, and economic data from several sources including randomized clinical trials, peer-reviewed literature, and expert opinion. Sensitivity analyses can be conducted by varying key parameter estimates within a reasonable range to assess the impact on the results and inferences. Preliminary results suggest that from a payer perspective, the upfront price of bone morphogenetic protein is likely to be entirely offset by reductions in the use of other medical resources. That is, bone morphogenetic protein appears to be cost neutral. The cost offsets were attributable largely to prevention of pain and complications associated with autogenous iliac crest bone graft, as well as reduction of the costs associated with fusion failures. Future research should focus on quantifying the health-related quality-of-life impact of bone morphogenetic protein relative to autogenous iliac crest bone graft, as well as the impact on lost productivity.